A Comparison between Automated Subjective Refraction and Traditional Subjective Refraction in Keratoconus Patients

SIGNIFICANCE The performance of the Eye Refract (Luneau Technology, Chartres, France), a new instrument to perform aberrometry-based automated subjective refraction, has been previously evaluated in healthy subjects. However, its clinical implications in other ocular conditions are still unknown. PURPOSE The purpose of this study was to evaluate the agreement between the Eye Refract and the traditional subjective refraction, as the criterion standard, in keratoconus patients with and without intracorneal ring segments (ICRSs). METHODS A total of 50 eyes of 50 keratoconus patients were evaluated, dividing the sample into 2 groups: 27 eyes without ICRS (37.78 ± 9.35 years) and 23 eyes with ICRS (39.26 ± 13.62 years). An optometrist conducted the refraction with the Eye Refract, and another different optometrist conducted the traditional subjective refraction on the same day. Spherical equivalent ( M ), cylindrical vectors ( J 0 and J 45 ), and corrected distance visual acuity were compared between both methods of refraction. In addition, Bland-Altman analysis was performed to assess the agreement between both methods of refraction. RESULTS There were no statistically significant differences ( P ≥ .05) between the Eye Refract and the traditional subjective refraction for all the variables under study in either group. Without ICRS, the mean difference and 95% limits of agreement (upper, lower) were −0.20 (+1.50, −1.89) D for M , −0.14 (+1.40, −1.68) D for J 0 , and +0.05 (+1.23, −1.14) D for J 45 . With ICRS, these values worsened to −0.62 (+3.89, −5.12) D for M , +0.06 (+2.46, −2.34) D for J 0 , and −0.02 (+2.23, −2.28) D for J 45 . CONCLUSIONS The Eye Refract seems to offer similar results compared with the traditional subjective refraction in keratoconus patients not implanted with ICRS. However, some patients could show abnormal measurements, especially those with ICRS, who should be treated with caution in clinical practice.